Why have so many innovations in the NHS failed to make the impact they might because they remain in isolated pockets and never spread? Here at the Innovation Unit we decided to look at this question from a more positive angle and ask where innovation has spread and what made that possible?

There is broad agreement that the pressures and challenges currently facing the NHS can only be addressed through developing and scaling innovations that significantly improve outcomes whilst significantly reducing costs. This is as true in musculoskeletal services as in other sectors.

But proven innovations and best practice tend to spread slowly in the NHS. Innovations such as first contact physiotherapist or ESCAPE-pain remained as isolated pockets of good practice long after they had been shown to be effective. ESCAPE-Pain is now rolling out in many areas, thanks to a grant from Sport England, but the first evidence that it worked was as long ago as 2007.

The barriers to spreading innovation have gained a lot of attention. The Innovation Unit, in collaboration with the Health Foundation, wanted to look at the enablers – what will help the spread of good practice. We looked at ten examples of successful spread of innovation in the NHS. Our report identifies common factors that enabled their spread. Whilst none of the case studies were in MSK, the key enablers we identified will apply equally well to MSK innovation.

Our eight key enablers

In pursuit of spread:
1. Building demand through existing networks and narratives
2. Using evidence to build demand
3. Balancing fidelity, quality and adaptability
4. Scaling vehicles rather than lone champions

Creating the conditions for spread:
5. Capitalising on national and local system priorities
6. Using policy and financial levers to kick start momentum
7. Commissioning for sustainable spread
8. External funding to support spread

Read Against the Odds for more on the eight key enablers and some provocations for system leaders, funders and innovators. We hope you will find it useful as you face the challenges of how to spread innovation and good practice in MSK across the NHS.